Representation of clinical practice guideline components in OWL

Serie : Advances in intelligent systems and computing, ISSN 2194-5357, vol. 221The main purpose to attain with the advent of clinical decision sup-port systems is either to improve the quality of patient care or to reduce the oc-currence of clinical malpractice, such as medical errors and defensive medicine. It is therefore necessary a machine-readable support to integrate the recommen-dations of Clinical Practice Guidelines in such systems. CompGuide is a Com-puter-Interpretable Guideline model developed under Ontology Web Language that offers support for administrative information concerning a guideline, work-flow procedures, and the definition of clinical and temporal constraints. When compared to other models of the same type, besides having a comprehensive task network model, it introduces new temporal representations and the possi-bility of reusing pre-existing knowledge and integrating it in a guideline.(undefined

Webifying the computerized execution of Clinical Practice Guidelines

The means through which Clinical Practice Guidelines are dissemi-nated and become accessible are a crucial factor in their later adoption by health care professionals. Making these guidelines available in Clinical Decision Sup-port Systems renders their application more personal and thus acceptable at the moment of care. Web technologies may play an important role in increasing the reach and dissemination of guidelines, but this promise remains largely unful-filled. There is a need for a guideline computer model that can accommodate a wide variety of medical knowledge along with a platform for its execution that can be easily used in mobile devices. This work presents the CompGuide frame-work, a web-based and service-oriented platform for the execution of Computer-Interpretable Guidelines. Its architecture comprises different modules whose in-teraction enables the interpretation of clinical tasks and the verification of clinical constraints and temporal restrictions of guidelines represented in OWL. It allows remote guideline execution with data centralization, more suitable for a work en-vironment where physicians are mobile and not bound to a machine. The solution presented in this paper encompasses a computer-interpretable guideline model, a web-based framework for guideline execution and an Application Programming Interface for the development of other guideline execution systems.This work is part-funded by ERDF - European Regional Development Fund through the COMPETE Programme (operational programme for competitiveness) and by National Funds through the FCT – Fundação para a Ciência e a Tecnologia (Portuguese Foundation for Science and Technology) within project FCOMP-01-0124-FEDER-028980 (PTDC/EEI-SII/1386/2012). The work of Tiago Oliveira is supported by doctoral grant by FCT (SFRH/BD/85291/2012)

Clinical decision support: Knowledge representation and uncertainty management

Programa Doutoral em Engenharia BiomédicaDecision-making in clinical practice is faced with many challenges due to the inherent risks of being a health care professional. From medical error to undesired variations in clinical practice, the mitigation of these issues seems to be tightly connected to the adherence to Clinical Practice Guidelines as evidence-based recommendations The deployment of Clinical Practice Guidelines in computational systems for clinical decision support has the potential to positively impact health care. However, current approaches to Computer-Interpretable Guidelines evidence a set of issues that leave them wanting. These issues are related with the lack of expressiveness of their underlying models, the complexity of knowledge acquisition with their tools, the absence of support to the clinical decision making process, and the style of communication of Clinical Decision Support Systems implementing Computer-Interpretable Guidelines. Such issues pose as obstacles that prevent these systems from showing properties like modularity, flexibility, adaptability, and interactivity. All these properties reflect the concept of living guidelines. The purpose of this doctoral thesis is, thus, to provide a framework that enables the expression of these properties. The modularity property is conferred by the ontological definition of Computer-Interpretable Guidelines and the assistance in guideline acquisition provided by an editing tool, allowing for the management of multiple knowledge patterns that can be reused. Flexibility is provided by the representation primitives defined in the ontology, meaning that the model is adjustable to guidelines from different categories and specialities. On to adaptability, this property is conferred by mechanisms of Speculative Computation, which allow the Decision Support System to not only reason with incomplete information but to adapt to changes of state, such as suddenly knowing the missing information. The solution proposed for interactivity consists in embedding Computer-Interpretable Guideline advice directly into the daily life of health care professionals and provide a set of reminders and notifications that help them to keep track of their tasks and responsibilities. All these solutions make the CompGuide framework for the expression of Clinical Decision Support Systems based on Computer-Interpretable Guidelines.A tomada de decisão na prática clínica enfrenta inúmeros desafios devido aos riscos inerentes a ser um profissional de saúde. Desde o erro medico até às variações indesejadas da prática clínica, a atenuação destes problemas parece estar intimamente ligada à adesão a Protocolos Clínicos, uma vez que estes são recomendações baseadas na evidencia. A operacionalização de Protocolos Clínicos em sistemas computacionais para apoio à decisão clínica apresenta o potencial de ter um impacto positivo nos cuidados de saúde. Contudo, as abordagens atuais a Protocolos Clínicos Interpretáveis por Maquinas evidenciam um conjunto de problemas que as deixa a desejar. Estes problemas estão relacionados com a falta de expressividade dos modelos que lhes estão subjacentes, a complexidade da aquisição de conhecimento utilizando as suas ferramentas, a ausência de suporte ao processo de decisão clínica e o estilo de comunicação dos Sistemas de Apoio à Decisão Clínica que implementam Protocolos Clínicos Interpretáveis por Maquinas. Tais problemas constituem obstáculos que impedem estes sistemas de apresentarem propriedades como modularidade, flexibilidade, adaptabilidade e interatividade. Todas estas propriedades refletem o conceito de living guidelines. O propósito desta tese de doutoramento é, portanto, o de fornecer uma estrutura que possibilite a expressão destas propriedades. A modularidade é conferida pela definição ontológica dos Protocolos Clínicos Interpretáveis por Maquinas e pela assistência na aquisição de protocolos fornecida por uma ferramenta de edição, permitindo assim a gestão de múltiplos padrões de conhecimento que podem ser reutilizados. A flexibilidade é atribuída pelas primitivas de representação definidas na ontologia, o que significa que o modelo é ajustável a protocolos de diferentes categorias e especialidades. Quanto à adaptabilidade, esta é conferida por mecanismos de Computação Especulativa que permitem ao Sistema de Apoio à Decisão não só raciocinar com informação incompleta, mas também adaptar-se a mudanças de estado, como subitamente tomar conhecimento da informação em falta. A solução proposta para a interatividade consiste em incorporar as recomendações dos Protocolos Clínicos Interpretáveis por Maquinas diretamente no dia a dia dos profissionais de saúde e fornecer um conjunto de lembretes e notificações que os auxiliam a rastrear as suas tarefas e responsabilidades. Todas estas soluções constituem a estrutura CompGuide para a expressão de Sistemas de Apoio à Decisão Clínica baseados em Protocolos Clínicos Interpretáveis por Máquinas.The work of the PhD candidate Tiago José Martins Oliveira is supported by a grant from FCT - Fundação para a Ciência e a Tecnologia (Portuguese Foundation for Science and Technology) with the reference SFRH/BD/85291/ 2012